With college health centers facing significant increases in the costs to provide health care services, as well as decreases in their funding sources, many health center administrators are having to think outside of the box for ways to extend budgets and maintain a high quality of care for their student patients. As a result, more college health center directors and their staffs are turning to commercial insurance plans.

"Health centers at many public institutions used to get 100 percent of their funding from the state, but times are changing," said Jennifer Lepus, director of university health services for the University of Maryland - Baltimore County.

The UM-BC student health center is one of hundreds nationally that have struggled with state budget cutbacks. Health centers at impacted schools may still receive some funding by offering student health insurance plans, but reimbursements from those plans - which are provided by a handful of companies that contract with colleges to offer exclusive group rated coverage to students - are typically not enough to support a health center budget.

"Our difficulty in offering only a group rated insurance program was that voluntary enrollment was not enough to sustain it," said Western Kentucky University's Health Services Director Libby Greaney. "So, WKU's solution has been to accept commercial insurance plans, and file those claims.

WKU began billing insurance companies in 2001, after student health fees were cut the previous year.

"If your doctors are board-certified and credentialed, they can establish themselves as primary care physicians. This enables you to see community patients who are in-network with the plans that your health center accepts. If balanced properly, you can increase your service net and your revenue streams."

According to Greaney, more and more schools are realizing the benefits of opening their health centers up to commercial plans, and taking a similar approach to WKU's.

"People are beginning to see the need. They are talking about it and addressing it," she said. "Those in college health who are resistant to the idea may be viewed as 'old school' if they do not embrace the concept."

"More and more senior vice presidents at colleges are hearing about this approach, and are giving the directive to their health centers. I would encourage health center staff to be more in the driver's seat."

But Greaney also recognizes a natural conundrum. While accepting commercial carriers can open up additional revenue streams for college health centers, it may also impact access to care. The reality is that not every student enrolls in school with insurance coverage. Students without coverage either go without care, or must pay out of pocket for medical costs that are growing more expensive each year.

With the American College Health Association and some states calling for colleges and universities to provide health care coverage to all students, some schools are offering a menu of options.

For example, Lepus and her staff at UM-BC have opted to accept both a student health plan and plans from commercial carriers.

"If the goal is for every student to have coverage, we can achieve that by offering both options," Lepus said. "The school plans are less expensive for people, but we have found that many young people today are covered by their parents' insurance plans until they turn 23 years old. That means that a large number of students have coverage through private carriers, and it seems logical that when they come in to be seen, we can bill those insurance companies."

The University of Utah at Salt Lake City is another example of a health center that has found that billing to commercial insurance carriers as well as offering a traditional student insurance plan through the university is a win-win for both students and the health center.

"By offering both options, we have a medium-sized pool of students who are required to come to us with their insurance, but we are also affordable and convenient for students with out of state insurance who will be paying out-of-network percentages or deductibles," said Tiffany Smith, office manager/patient advocate for the University of Utah at Salt Lake City's health center, which attracts about 7,000 students each year. "When we bill commercial insurance carriers, we make the process easier for our student patients, and this keeps them coming back to us in the future."

And when they come back, it means additional revenue for the health center.

Although accepting commercial insurance carriers might seem overwhelming, Greaney offers a bit of advice to other health center directors who are considering it:

"Start small, and utilize the resources that are available to you," she said. "Namely, people who have gone through this either in college health or out in the community."